The American Society for Radiation Oncology (ASTRO) has issued a new clinical practice statement for neoadjuvant and adjuvant radiation therapy for patients with moderately advanced rectal cancer based on their risk of recurrence. The statement also examines nonoperative therapies for patients who are medically inoperable or refuse surgery.

“Advancements in treatment options over the past three decades – including more refined surgical techniques, more effective systemic agents, and more focal and shorter-course RT options – have drastically lowered recurrence rates, creating situations where one or more modalities may be omitted and the side effects of treatment may be reduced,” ASTRO noted in a written statement .

“This statement provides practicing physicians with an idea of how to employ alternative treatment options for rectal cancer patients, such as short-course radiation therapy or nonoperative management approaches. It also lets us identify patients who may be more amenable to different treatment sequencing options, rather than grouping everyone with stage II and III rectal cancer together for a single standard trimodal treatment approach. There are cases where we can achieve the same survival benefit with less treatment,” said Karyn A. Goodman, MD, of the University of Colorado. Dr. Goodman was the lead author of the practice statement’s executive summary.

The clinical practice statement was developed with the RAND/UCLA Appropriateness Method, where oncology, gastroenterology, and internal medicine physicians and experts rate the appropriateness of different treatment approaches for different clinical scenarios based on a systematic review of published research.

Neoadjuvant chemoradiation was rated “appropriate” for all scenarios, neoadjuvant brachytherapy was rated “rarely appropriate” for all scenarios, neoadjuvant chemotherapy was rated “may be appropriate” for intermediate- and moderately-high-risk patients, and “rarely appropriate” for the other scenarios, while forgoing neoadjuvant therapy was rated potentially appropriate only for cases with higher tumors situated far from the mesorectal fascia.

Complete recommendations can be found in the ASTRO Clinical Practice Statement published in the May-June 2016 issue of Practical Radiation Oncology.

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